JOURNAL OF MEDICAL INTERNET RESEARCH Evans et al

Original Paper

Review of Mobile Apps for Women With Anxiety in Pregnancy:

Maternity Care Professionals’ Guide to Locating and Assessing
Anxiety Apps

Kerry Evans1*, BSc, MA, PhD; Jasper Donelan2*, PhD; Stefan Rennick-Egglestone3*, PhD, MA; Serena Cox1*,
BSocSci; Yvonne Kuipers4*, PhD
1
School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
2
Digital Research, University of Nottingham, Nottingham, United Kingdom
3
School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
4
Edinburgh Napier University, School of Health and Social Care, Edinburgh, United Kingdom
*
all authors contributed equally

Corresponding Author:
Kerry Evans, BSc, MA, PhD
School of Health Sciences
University of Nottingham
Medical School
Queen's Medical Centre
Nottingham, NG7 2HA
United Kingdom
Phone: 44 115 95 15559
Email: kerry.evans1@nottingham.ac.uk

Abstract
Background: Mental health and pregnancy apps are widely available and have the potential to improve health outcomes and
enhance women’s experience of pregnancy. Women frequently access digital information throughout their pregnancy. However,
health care providers and women have little information to guide them toward potentially helpful or effective apps.
Objective: This review aimed to evaluate a methodology for systematically searching and reviewing commercially available
apps that support pregnant women with symptoms of anxiety in order to assist maternity care professionals in identifying resources
that they could recommend for these women.
Methods: A stepwise systematic approach was used to identify, select, describe, and assess the most popular and highly user-rated
apps available in the United Kingdom from January to March 2021. This included developing a script-based search strategy and
search process, writing evaluation criteria, and conducting a narrative description and evaluation of the selected apps.
Results: Useful search terms were identified, which included nonclinical, aspirational, and problem-based phrases. There were
39 apps selected for inclusion in the review. No apps specifically targeted women with anxiety in pregnancy. Of the 39 apps
included in the review, 33 (85%) focused solely on mind-body techniques to promote relaxation, stress reduction, and psychological
well-being. Only 8 of the 39 (21%) apps included in the review reported that health care professionals had contributed to app
development and only 1/39 (3%) provided empirical evidence on the effectiveness and acceptability of the app. The top 12/39
(31%) apps were evaluated by 2 independent reviewers using the developed criteria and scores. There was a small negative
correlation between the reviewers’ scores and app user rating scores, with higher user rating scores associated with lower reviewer
scores.
Conclusions: App developers, publishers, and maternity care professionals should seek advice from women with lived experience
of anxiety symptoms in pregnancy to locate, promote, and optimize the visibility of apps for pregnant women. There is a lack of
resources that provide coping strategies based on current evidence for the treatment of anxiety in pregnancy. Maternity care
providers are limited in their ability to locate and recommend acceptable and trustworthy apps because of the lack of information
on the evidence base, development, and testing of apps. Maternity care professionals and women need access to libraries of trusted
apps that have been evaluated against relevant and established criteria.

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(J Med Internet Res 2022;24(3):e31831) doi: 10.2196/31831
KEYWORDS
anxiety; pregnancy; antenatal; mobile applications; digital interventions; mHealth; mobile app; psychological well-being; maternity;
evaluation; quality assessment
Introduction
Many pregnant women experience symptoms of anxiety; the
prevalence of antenatal anxiety symptoms has been reported to
be 13%-23% [1-3]. During the COVID-19 pandemic, the
number of women with symptoms of anxiety in pregnancy has
increased due to women’s concerns about virus transmission,
accessing care, and social support [4,5]. Anxiety symptoms in
pregnancy usually have similar affective and cognitive attributes
to anxiety symptoms at other times [6], although concerns
related to pregnancy may present as the predominant feature.
Mild anxiety in pregnancy may be normal to prepare women
for motherhood and protecting the fetus [6,7]. Anxiety
symptoms become problematic when a significant amount of a
woman’s time is consumed, when women are unable to redirect
their focus to other tasks, or when everyday life and relationships
are affected [6,8,9]. Antenatal anxiety is reported to be
associated with postpartum depression, greater use of
interventions during labor, reduced rates of breastfeeding,
prematurity, and preterm birth [10-12].
The provision of web-based advice via mobile phones and the
internet has been suggested to help reduce anxiety and stress in
pregnant women [4,13]. Digitally delivered interventions are
potential solutions to overcoming barriers to access treatment
for perinatal mental health disorders. Interventions can be
delivered as unguided resources to support or replace
patient-provider interactions or as guided interventions that may
include live interactions over telephone or video or contact with
therapists using digital messaging [14]. Increasing midwives’
and maternity care providers’ awareness of digitally delivered
information and supportive interventions could assist in
signposting pregnant women to effective resources [15]. During
pregnancy, women frequently access digital information [16],
although information accessed through web-based sources is
rarely discussed with health care providers and the providers
themselves may be unaware of web-based information and its
accuracy [17]. Mobile apps have the potential to positively
influence health behavior and health outcomes [18,19] and
enhance women’s experience of maternity care and pregnancy
[20]. The availability of mobile apps has increased significantly
over the past few years. There are currently more than 400,000
health apps available from Google Play [21] and the App Store
[22]; however, there are fewer than 10,000 downloads for many
of these apps and 25% are never used after installation [18].
Mental health and pregnancy apps are widely available;
however, health care providers and women have little
information on which apps may be helpful or which to avoid
because these are ineffective or have potentially harmful content
[23]. Platforms such as the NHS Apps Library [24] have only
recently been developed to assist patients and the public in
finding trusted health and well-being apps and include general
pregnancy and mental health apps [25]. User ratings presented
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by the app stores, on the other hand, do not provide a measure
of clinical appropriateness, safety, or efficacy, and the
availability of clinical data to guide app recommendations is
poor [23]. Moreover, the health app industry is commercially
dominated and lacks regulation [16].
Health apps for use in pregnancy or to support individuals with
anxiety symptoms have been assessed as having poor quality
[26-28], lacking evidence-based content [29], and being
ineffective or potentially harmful [30]. Other reviews of
pregnancy apps have reported that apps contained little or no
pregnancy-specific information [26] and contained information
that was potentially harmful for pregnant women [31]. Health
professionals and app users have reported a preference for using
pregnancy apps that are relevant to their local health care context
and come from a trusted source. There is a need for greater
health professional engagement in app development and
increased awareness of and guidance for use of these resources
[16].
Several methodologies have been proposed for evaluating the
quality of apps [23,25], but the validity of app rating measures
is not yet established [18] and standardized measures with high
interrater reliability are required. Nouri et al [18] conducted a
systematic review of existing health app assessment tools
(N=23). In total, there were 38 main classes of assessment
criteria, which the reviewers arranged into 7 main criteria:
Design, Information/Content, Usability, Functionality, Ethical
Issues, Security and Privacy, and User-perceived value. Powell
et al [23] evaluated the interrater reliability of existing app
quality measures, but only criteria for “App interactiveness”
and “feedback” reached the threshold for agreement, with items
related to security and privacy, number of ratings, research base,
authorship, attribution, and product advisory support reaching
near threshold levels of agreement (α levels of .5 or more).
Items with low interrater reliability (α .3 or less) included more
subjective measures, including perceived and claimed
effectiveness, ease of use, errors, and performance issues. The
authors state that even more objective measures can be missed
by a reviewer and suggest that the evidence base of the app may
be a more reliable indicator of effectiveness. Therefore,
clinicians need to review apps personally before making
recommendations, discuss apps with colleagues and service
users, and apply clinical judgment [23].
The purpose of this review was to evaluate a methodology to
systematically search and review commercially available apps
to support pregnant women with symptoms of anxiety. The
review focused on identifying app resources that could be used
to complement maternity and perinatal mental health care and
identifying methods of searching and evaluation that can be
adopted by maternity care professionals with limited time and
resources.
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Methods
This review adopted a stepwise systematic approach to identify,
select, describe, and assess the most popular and highly
user-rated apps available in the United Kingdom from January
to March 2021. The review team included individuals with
expertise in maternity care and research, mental health care,
and digital research and a lived experience of maternity. Ethics
approval was not required for this review because primary data
were not collected.
Developing an App Search Strategy
The first stage involved identifying key search words and terms
(Table 1). Research and academic keywords and Medical
Subject Headings terms (eg, Anxiety AND Pregnancy) were
piloted on Android (Google Play, Google) and iOS (App Store,
Apple). These search terms led to limited results and did not
locate preidentified “marker” apps (Mind the Bump [32] and
Headspace [33]). The Headspace and Mind the Bump apps were
selected as marker apps because they are recommended by the
National Health Service or established mental health charities.
General phrases were brainstormed by the review team,
considering terms that women may use to search for resources
Table 1. Developing search terms for Google Play and the App Store.
Research literature searching keywords Web-based words and phrases
Pregnancy, antenatal, perinatal, childbearing Pregnant, pregnancy, motherhood, mother (mum, mom, mama, momma), baby, birth (childbirth),
miscarriage, movements (fetal/baby movements), labor, maternity
Anxiety Anxious (anxiety), worry (worries), concerns; stress, distress; ear, panic, scared, nervous; mind,
emotion, thoughts, mood; mental health; therapy (CBTa); relax, calm; cope (coping); help, care,
relief, cure; wellbeing
a
CBT: cognitive behavioral therapy.
Search Process
To identify efficient and effective search terms that could be
used by maternity care professionals, previously developed
scripts were used to search the UK version of Google Play and
the App Store. The search was conducted from January to March
2021 using the script-based approach developed by Stawarz et
al [35]. The scripts were modified using alternative combinations
of the suggested keywords. Each combination of keywords and
the number of apps located are shown in Multimedia Appendix
1. Search results included the app name, short description, rating,
and developer’s details. After script-based searching, a simple
web-based keyword search of Google Play and the App Store
was performed to compare the search results with those of
script-based searching and to locate additional apps. Changing
the country code (ie, United Kingdom, United States) did not
appear to impact the search result. Changing the word order
resulted in different search results on Google Play but not on
the App Store. Manual screening of the app search results was
completed by evaluating the app title and description against
the inclusion and exclusion criteria.
Identifying Evaluation Criteria for the Apps
Evaluation criteria that considered the findings from existing
pregnancy and mental health app reviews were selected. The
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as well as descriptive and marketing terms that app developers
might employ. The search strategy also considered the work by
Wexler et al [34] in a study related to our own. Wexler et al
[34] analyzed data from pregnancy social media forums. They
found that the frequency of word appearance in relation to other
words revealed clusters of words that have a high probability
of appearing together around certain topics. Therefore, word
clusters for anxiety about pregnancy and labor were included
in the search terms. Members of an established public
involvement group also contributed by identifying words they
would use to locate information and resources. Service users
highlighted that women may also search for specific
pregnancy-related aspects that cause anxiety (eg, miscarriage,
giving birth) or use words to describe how they would like to
feel (eg, calm, stress-free, relaxed). Again, these were included
in the key search words and terms for the present review.
Apps were included in the review if they were available in
English, aimed at or referred to use in pregnancy, and included
advice, information, exercises, or techniques to improve
symptoms of anxiety, worry, fear, or stress. Exclusion criteria
were anxiety apps that did not reference pregnancy in the app
information and pregnancy apps that did not reference anxiety,
worry, stress, fear, or emotional or mental health.
criteria were therapeutic or supportive content (reflective of the
evidence base or clinical standards) [29,35,36], relevance for a
pregnant population [26,31,37], and compliance with existing
app quality measures (Multimedia Appendix 2). The following
therapeutic or supportive content was evaluated against
review-level evidence and clinical recommendations for
perinatal and common mental health disorders [38-41]:
1. Psychoeducation: Aids in the identification of anxiety
disorders and improves understanding and treatment options
for anxiety.
2. Low-intensity psychological interventions including
individual nonfacilitated, guided self-help or psychoeducational
group. Includes written or electronic materials based on the
treatment principles of cognitive behavioral therapy (CBT).
3. Mind-body interventions such as yoga or hypnotherapy.
4. Referral and signposting to services for women requiring
specialist diagnosis and care.
It is important to consider whether the current evidence for an
app is sufficient or relevant for a particular population [37].
Therefore, the following questions were developed by the
reviewers to identify the availability of information that women
could search for [42].
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1. How do I know if I have anxiety? Analysis

2. How do I know the severity of my anxiety symptoms?
3. Where can I go for help for my anxiety in pregnancy?
4. How can I access specialist help for my anxiety in pregnancy?
5. What are the treatment options for anxiety during pregnancy?
6. What can I do to help my anxiety symptoms?
Based on the review by Nouri et al [18], quality criteria were
selected to meet the review objectives. Subjective measures of
app quality have been reported as having low interrater
reliability [23]. Quality criteria were therefore selected that
focused on objective measures and minimized the number of
subjective responses. Efforts to reduce the subjective measures
also considered end-user preference. Criteria identified by health
care professionals as important may not reflect women’s needs
and preferences, as different individuals may find a particular
app more or less useful depending on their personal needs,
circumstances, experiences, and education level [25,43]. User
ratings as reported in Google Play and the App Store were also
presented alongside reviewers’ evaluation scores for comparison.
Descriptive data were collected (where available) for all apps
included in the review. This included the app developer and
country, number of downloads, number of ratings, rating score,
version number, costs, and date of the last update. Narrative
description and evaluation of the highest scoring, free to
download, and most popular apps were completed [29]. Apps
were identified based on the app download numbers and user
rating (0-5 stars) provided by Google Play and the App Store:
more than 10,000 installs, a star rating of 3.5 or higher, and free
to download in Google Play; and more than 10 ratings, a star
rating of 3.5 or higher, and free to download in the App Store.
This resulted in the selection of 12 apps that were then evaluated
by 2 independent reviewers using the criteria presented in
Multimedia Appendix 2. The extent to which the app addressed
the criteria was scored on a 2-point scale (0, information is
absent/negative response; 1, information is present/positive
response). The overall score was calculated and interpreted with
caution because of the lack of validity and reliability of app
quality measures [23]. Scores were used to assist in interpreting
the review findings and to generate discussion on the
mechanisms for selecting and recommending potentially
beneficial apps (Table 2).

Table 2. Quality scores of the highest user rated and most popular apps in the review.
App name
Antenatal Yoga, Meditation + Educa-
tion (YogiBirth)
Baby Buddy
Carry: Pregnancy Workouts
Hypnobirthing: Calm Birth
Hypnobirthing - Pregnancy, Music &
Tracker
IHypnobirth
Keleya: Pregnancy Fitness & Tracker
+ Baby Due Date
Music for Pregnancy Relaxation
Pregnancy Care Tips
Pregnancy Music Collection 200
Pregnancy Yoga Exercises
Pregnancy Yoga Exercises – Prenatal
Yoga
Maternity and mental health General app features quality Combined score
policy and evidence base score (out of 8)
score (out of 6)
1 3
4 7
5 4
1 3
1 3
1 4
1 5
0 3
0 1
0 2
1 4
1 3
User rating score from
(out of 14) Google play/App store (out
of 5)
4 4.3/4.7
11 2.8/4
9 —/4.7
4 —/4.4
4 3.4/—
5 —/3.8
6 4.1/—
3 4.2/—
1 3.6/—
2 4.4/—
5 4.0/—
4 3.8/—

pregnancy and included stress relief, relaxation, and mental

Results
Apps Located and Included in the Review
In total, 1391 apps were located, and 1337 (96%) apps were
subsequently excluded based on the title, description, and
duplication (Figure 1). A total of 39/1391 (3%) apps were
included in the review (Multimedia Appendix 3).
No apps specifically targeted women with anxiety in pregnancy.
Various apps focused on providing well-being support during
health advice as part of a general approach to well-being in
pregnancy. Of the 39 apps included in the initial review, 33
(85%) focused solely on mind-body techniques to promote
relaxation, stress reduction, and psychological well-being.
Mind-body techniques included relaxation, mindfulness,
hypnosis, yoga, positive affirmations, and meditation. A total
of 3/39 (8%) apps provided informational support, of which 1
(33%) focused on psychoeducation and 2 (67%) were
multicomponent and provided information support, cognitive,

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or mind-body techniques. Only 8 of the 39 (21%) apps included
in the review reported that health care professionals had
contributed to app development (Figure 2). Only 1/39 (3%) app
(Baby Buddy) provided empirical evidence on the effectiveness
and acceptability of the app.
Figure 1. Adapted PRISMA diagram: anxiety apps for pregnant women. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2. Yoga, relaxation and hypnobirthing apps.
Description of the Apps Included in the Evaluation
Yoga, Relaxation, Meditation, and Hypnobirthing Apps
Of the 12 apps, 7 (58%) provided elements of relaxation,
hypnobirthing, yoga, and relaxation (Figure 2) [44-50]. Of the
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There was a small negative correlation between the reviewers’
scores and the user rating scores (r=−0.27; 12/39, 31%; P=.39)
with higher user rating scores associated with lower reviewer
scores.
7 apps, 4 (57%) provided exercises to improve mood, anxiety
coping, or mental well-being [44-47], although no supporting
evidence or information about anxiety or mental well-being was
provided. Only 1/7 (14%) app [48] included information about
depression and anxiety in pregnancy and the postnatal period
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via links to national health care websites and helplines for
factsheets.
Music Apps
Of the 12 apps, 2 (17%) provided music for relaxation in
pregnancy and were very similar in content and appearance:
Music for Pregnancy Relaxation [51] and Pregnancy Music
Collection [52]. Updates had not been completed within 12
months of the review. Both apps reported that music could
reduce stress and anxiety in pregnancy and support fetal brain
development. No empirical evidence was provided to support
the claims. Both apps provided recordings of classical music
or soothing sounds through a simple interface.
Informative Apps
Pregnancy Care Tips [53] was available on Android and iOS
devices, although it had not been updated within 5 years of the
review. At the time of publication, the app was no longer
available to download. The app provided written “tips” and
information on pregnancy symptoms, diet, exercise, and
maternity care. The information appeared to have been translated
into English and certain phrases and terms were difficult to
understand and not reflective of UK maternity care procedures.
No information was provided on the development of the app,
professional input, or supporting evidence.
Keleya: Pregnancy Fitness & Tracker + Baby Due Date [54]
was available on Android and iOS devices. Keleya was
promoted as an “All-in-One App” for pregnancy and contains
yoga exercises, nutritional advice, and information on the
progress and symptoms of pregnancy. Content was provided in
written and audio material, which could be personalized by
responding to user input and detailing stage of pregnancy, goals,
and symptoms. The app reported reducing anxiety through
meditation exercises. No empirical evidence was provided, and
there was no information on app development or health care
professional input. Free content was very limited, and additional
features such as social media community access, information,
and exercises required a subscription fee. Information on anxiety
in pregnancy was limited to user input to track anxiety
symptoms with no further information, support, or signposting
available.
Baby Buddy [55] is a National Health Service–endorsed app
from the charity Best Beginnings. The app was updated within
1 month of the review and is free on Android and IOS devices.
A website link from the app provided links to evaluation and
impact studies within UK maternity care institutions. The app
reported guiding women through pregnancy by providing
information through written and video materials. Baby Buddy
provided numerous video clips on the topic of anxiety and
depression, although there were no specific resources to help
women develop coping strategies and techniques to manage
symptoms of anxiety. The information included an overview
of anxiety disorders, CBT approaches, how or when to seek
help with mental health, and the benefits of peer support. Baby
Buddy reported that the text and video clips were quality-assured
by professional Royal Colleges and other health organizations.
The app was interactive and enabled women to make notes of
questions to ask their midwife and input information to access
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personalized content. Signposting was provided for local
maternity services and support groups.
Discussion
Locating and Evaluating Apps
The purpose of this review to evaluate a methodology to
systematically search for and review commercially available
apps was addressed by identifying useful search terms that were
nonclinical and included aspirational phrases as suggested by
the study service user group. The terms included “calm,”
“relax,” “relief,” “cope,” and “well-being” as well as some
problem-based phrases such as “stress,” “fear,” and “anxiety.”
However, no clear recommendations were identified for the
searching of apps to help maternity care professionals identify
useful resources.
The evaluation components developed for the review provided
a useful framework for maternity care professionals to assess
the therapeutic or supportive content in the context of pregnancy.
The quality criteria focused on more objective measures and
aimed to minimize the number of subjective responses.
However, the binary coding (1, information/component present;
0, information/component absent) was not amenable to capture
criteria that were partly addressed by the app or where particular
types of content were presented differently within the app
[42,56]. The quality criteria have been revised in response to
the findings and are presented in Multimedia Appendix 4. Furter
studies to evaluate the reliability of the criteria are required [18].
Many of the apps that purported to reduce anxiety symptoms
did not include any link to peer-reviewed literature or the
evidence base. Other reviews have reported the lack of provision
of evidence-based app content [28,35,36,56]. Although
web-based mindfulness and CBT approaches have been reported
as effective in reducing anxiety and other mental health concerns
in perinatal populations [57,58], evidence-based information
was not presented in the apps. The lack of clearly defined
content with links to the evidence base may hinder the ability
of maternity care professionals to determine the quality of the
app [56]. However, this review highlighted that only 1 of the 7
(14%) most popular and highly rated mind-body apps provided
any rationale for the approach or links to the evidence base.
The lack of correlation between the presence of evidence-based
information or strategies and the popularity of mental health
apps has been highlighted in recent reviews [35,56,59]. This
suggests that features other than the provision of evidence-based
information are important to and valued by women [35]. To
further highlight this point, this review has demonstrated that
the quality evaluation scores assigned by the review team (health
care professionals and researchers) did not reflect user ratings
(displayed by the app platforms). Because of the lack of
information on the development of the apps, it is difficult to
know whether women’s views were accessed or whether the
design and content of the app reflected women’s needs.
User experience and engagement are important factors in the
overall effectiveness of apps [35]. Stawarz et al [35] identified
that interactive features and customization were important in
improving user engagement with CBT for depression. Positivity
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(ability to capture positive and negative thoughts) along with
privacy, security, and trust was associated with improved user
experience. For this review, engagement with service users also
highlighted that women may wish to use “positive” and
aspirational words to describe how they would like to feel (eg,
calm, stress-free, relaxed) when they search for potentially
useful apps. Researchers should aim to make mobile health
interventions with evidence-based treatments attractive and
accessible and focus on user desirability and experience early
in the design phase [59]. A combination of approaches to
maximize user engagement and experience with evidence-based
strategies is required to deliver potentially effective app-based
strategies to support women with anxiety in pregnancy.
Pregnant women may benefit from remotely delivered
interventions to help them cope with symptoms of anxiety if
they are provided with web-based contact with a health care
professional or peer community and may be more motivated to
complete interventions that are perceived as relevant or tailored
to their needs and situations [60]. Only 2 of the 39 (5%) apps
included in the review provided a psychological therapeutic
approach, with most apps providing mind-body techniques and
exercises to support women’s general well-being throughout
pregnancy, labor, and birth. Only 1/39 (3%) app was endorsed
by a health care organization (Baby Buddy). Although it did
not provide any therapeutic content, this app did provide
information and signposting. Apps that offered coping strategies
for women with symptoms of anxiety had very little information
about how or when to seek help or signposting to supportive
services.
The apps included in this review were promoted as either general
pregnancy well-being apps (including diet, exercise, fetal growth
and well-being, labor, and birth) or general relaxation apps.
This review did not locate any apps that were solely focused
on anxiety symptoms in pregnancy. A systematic review of
perinatal web-based psychological treatments for clinical levels
of maternal anxiety and depression [61] also did not locate any
interventions targeted to the reduction of anxiety disorders or
comorbid depression and anxiety. Although no interventions
were tailored to anxiety or recruited women with a diagnosed
anxiety disorder, the pooled analysis demonstrated medium and
significant group differences favoring web-based interventions
over control conditions for anxiety outcome measures. The
authors of this previous systematic review recommend that
interventions be specifically developed for this neglected area
of perinatal mental health care.
The perceived reliability and trustworthiness of web-based
pregnancy information have been reported to increase in women
when the resource is regularly updated and when it is
recommended by a health care professional [62]. Involvement
of the health care provider has been reported to help individuals
understand what apps can and cannot do [29]. Evaluation of
app quality by health care professionals should not be a
substitute for women’s preferences, usability, and other personal
factors necessary for selecting an app [29]. Zelmer et al [63]
sought consensus from a broad group of stakeholders on guiding
principles and criteria for a framework to assess e-mental health
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apps. The resulting principles are similar to the criteria
developed for this review across categories of security, usability,
evidence base, and functionality. It would not be possible for
most maternity care professionals to assess the fast-growing
health apps market. Access to technologies, curated
compilations, or libraries of effective apps would, however,
help maternity care professionals feel more confident in
recommending and signposting women to potentially beneficial
resources [25,64]. Platforms such as the NHS Apps Library
have started to develop such resources, inviting developers to
submit apps for assessment of regulatory, clinical, security, and
technological criteria [65].
Study Strengths and Limitations
For this review, potentially useful criteria for rating the quality
of the content and the function of apps were suggested to support
women with symptoms of anxiety in pregnancy. The criteria
were based on previous research, and validity and reliability
testing was not conducted nor was it within the remit of the
study. The security and privacy policies of each app were not
fully scrutinized, although an assessment of whether security
and privacy policies were reported in the app information was
included. The American Psychiatric Association has developed
a framework for app evaluation [37], which begins with the
assessment of compliance with safety and privacy criteria. These
criteria must be met before the evaluation continues to assess
benefit and efficacy, engagement, and data sharing. Simply
checking for the existence (or absence) of a privacy policy will
help identify questionable apps [37].
Conclusions
Locating potentially useful apps is not a straightforward process
and requires a different approach to that used in traditional
academic search. Keywords that reflect women’s search queries
and that can help women and maternity care providers navigate
app libraries need to be developed. App developers, publishers,
and maternity care professionals should seek advice from
women with lived experience of anxiety symptoms in pregnancy
to locate, promote, and optimize the visibility of apps for a
diverse population of pregnant women. This review did not
locate any resources that provided coping strategies or
therapeutic approaches for anxiety that were based on the current
evidence base for the treatment of anxiety in pregnancy. The
rationale, development, and testing of apps included in this
review were underreported, which may hinder the ability of
maternity care providers to easily locate useful, acceptable, and
trustworthy resources. Potentially useful quality criteria have
been presented, which require further development and testing.
Maternity care professionals should be aware that features of
apps other than the provision of evidence-based information
and approaches are important to app users. Features such as
interactivity and customization may improve user engagement,
and positive framing using aspirational statements may attract
women with symptoms of anxiety when they look to select an
app resource. Maternity care professionals and women would
benefit from access to libraries of trusted apps that have been
evaluated against relevant and standardized criteria.
J Med Internet Res 2022 | vol. 24 | iss. 3 | e31831 | p. 7
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 JOURNAL OF MEDICAL INTERNET RESEARCH Evans et al

Acknowledgments
The authors would like to acknowledge Dr Katarzyna Stawarz from the University of Cardiff for advice and support with developing
the script searches. The study was completed as part of the HEE/NIHR Clinical Lectureship award undertaken by KE. SRE
received funding by the National Institute for Health Research (NIHR) through its Programme Grants for Applied Research
Programme (Programme Grants for Applied Research, Personal experience as a recovery resource in psychosis: Narrative
Experiences Online (NEON) Programme, RP-PG-0615-20016). YK is a management committee member of COST action
CA18211: DEVoTION: Perinatal Mental Health and Birth-Related Trauma: Maximising best practice and optimal outcomes. SC
received funding by the NIHR Applied Research Collaboration East Midlands (ARC EM). The views expressed in this publication
are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Conflicts of Interest
None declared.

Multimedia Appendix 1
Keyword results in the search strategy.
[DOCX File , 16 KB-Multimedia Appendix 1]

Multimedia Appendix 2
Suggested criteria for evaluating the quality of apps for women with anxiety in pregnancy.
[DOCX File , 15 KB-Multimedia Appendix 2]

Multimedia Appendix 3
Included apps from Google Play and App Store (information accessed March 4, 2021).
[DOCX File , 23 KB-Multimedia Appendix 3]

Multimedia Appendix 4
Evaluation criteria for pregnancy anxiety apps (adapted from Van Singer et al [42] and Nouri et al [18]).
[DOCX File , 15 KB-Multimedia Appendix 4]

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Abbreviations
CBT: cognitive behavioral therapy

Edited by R Kukafka; submitted 06.07.21; peer-reviewed by K Stawarz, C Reis, UH Mohamad; comments to author 03.11.21; revised
version received 11.12.21; accepted 16.12.21; published 23.03.22
Please cite as:
Evans K, Donelan J, Rennick-Egglestone S, Cox S, Kuipers Y
Review of Mobile Apps for Women With Anxiety in Pregnancy: Maternity Care Professionals’Guide to Locating and Assessing Anxiety
Apps
J Med Internet Res 2022;24(3):e31831
URL: https://www.jmir.org/2022/3/e31831
doi: 10.2196/31831
PMID:

©Kerry Evans, Jasper Donelan, Stefan Rennick-Egglestone, Serena Cox, Yvonne Kuipers. Originally published in the Journal
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the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet
Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/,
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